Provider Demographics
NPI:1225039019
Name:LABORATORIO CLINICO JUNCOS; INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO JUNCOS; INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:GUSTAVO
Authorized Official - Last Name:SUERO
Authorized Official - Suffix:SR
Authorized Official - Credentials:PRESIDENTE
Authorized Official - Phone:787-687-1926
Mailing Address - Street 1:PO BOX 1920
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-3258
Mailing Address - Country:US
Mailing Address - Phone:787-687-1926
Mailing Address - Fax:787-687-0207
Practice Address - Street 1:30 TEODOMIRO DELFAUS
Practice Address - Street 2:
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777-3258
Practice Address - Country:US
Practice Address - Phone:787-687-1926
Practice Address - Fax:787-687-0207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-03
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR230291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
0038251Medicare PIN
0038251Medicare Oscar/Certification